objective To summarize the clinical experience of pancreatoduodenectomy using Da Vinci surgical system,and to investigate the methods to improve its efficacy.Methods Sixteen patients who received pancreatoduodenectomy from January to December 2009 at the General Hospital of Second Artillery of PLA were divided into robotic group(n=8)and open group(n=8).Data on the surgical procedure,perioperative management and postoperative recovery between the 2 groups were retrospectively analysed using t test and chi-square test.Result The radical resection rates of robotic group and open group were 7/8 and 8/8,respectively,with no significant difference between the 2 groups(χ~2=1.067,P＞0.05).The operation time of robotic group was (718±186)minutes,which was significantly longer than(420±127)minutes of open group(t=3.714,P＜0.05＝.The blood loss of robotic group was(153±43)ml,which was significantly less than(210±53)ml of open group(t=2.318,P＜0.05＝.The postoperative ambulation time and length of hospital stay of robotic group were(28±7)hours and(16±4)days,which were significantly shorter than(96±18)hours and(24±7)days of open group(t=9.939,2.714,P＜0.05＝.The incidences of postoperative complications of robotic group and open group were 2/8 and 6/8,respectively,with significant difference between the 2 groups(χ~2=6.349,P＜0.05＝.The incidences of anastomotic leakage of robotic group and open group were 2/8 and 3/8,respectively,with no significant difference between the 2 groups(χ~2=0.291,P＞0.05).Conclusion Pancreatoduodenectomy performed by Da Vinci surgical system is feasible and safe,and with the advantages of less trauma and rapid recovery of patients.

Objective To summarize the clinical experience of operations with Da Vinci surgical system in 27 patients with previous abdominal surgery.Methods The clinical data of 27 patients with previous abdominal surgery who had received reoperation using Da Vinci surgical system at General Hospital of Second Artillery of PLA from January to December 2009 were retrospectively analysed.The distribution of trocars was designed according to the surgical sites and previous surgical incision sites.The operation was divided into 2 steps:firstly,intraabdominal adhesion was dissected and the robotic arms were set up;secondly,the lesions were resected.Experience in trocars placement,surgical approach and management of complications were summarized.Results Six approaches were designed according to previous incision sites.Of all patients,22 were with severe intraabdominal and hepatic hilar band adhesion,and 5 with strip adhesion.One patient who underwent intraabdominal radiotherapy and chemotherapy abandoned robotic surgery because of the failure in trocar placement and pneumoperitoneum establishment.Twenty-six patients had successfully undergone robotic surgery and the success rate was 96%(26/27).Of the 26 patients,1 was complicated with enterorrhexis intraoperatively and received repairment.No postoperative complication was observed.Conclusions Previous abdominal surgery has little influence on robotic surgery with Da Vinci system. Pneumoperitoneum establishment,insertion point of the first trocar and dissection of the intraabdominal adhesions are key points for success of operation.

BACKGROUND: There are many species of ceramic bonding systems supplied in market, the mechanical strength is aprerequisite condition for resin cement in clinical use.OBJECTIVE: To study the difference of mechanical strength between Panavia F resin cement and self-made resin cement,DESIGN, TIME AND SETTING: A controlled observational study was performed in the prosthesis laboratory of the FourthMilitary Medical University of Chinese PLA between May 2006 and March 2007.MATERIALS: Panavia F resin cement was sourced from KURARAY MEDICAL INC. (Japan), experimental resin cement wasproduced by College of Stomatological Medicine in the Fourth Military Medical University of Chinese PLA.METHODS: Five cylindrical compressive strength specimens at an 8-mm height and 4-mm diameter were prepared, as well as5 cylindrical diametral tensile strength specimens at a 3-mm height and 6-mm diameter. AGS-500 universal material testingmachine was applied to detect the compressive strength and diametral tensile strength.MAIN OUTCOME MEASURES: The diametral tensile strength test and compressive strength test of the specimens.RESULTS: The compressive strength of Panavia F resin cement was remarkably higher than that of experimental cement[(238.92±24.54), (149.08±12.13) M Pa, P ＜ 0.05]. There were no significances between two resin cements on diametral tensilestrength (P＞ 0.05).CONCLUSION: There were no significance between two resin cements on diametral tensile strength following completecuring. The compressive strength of experimental resin cement can reach the standard of ADA (＞ 70 MPa) although it is lowerthan the compressive strength of Panavia F resin cement.

Objective To summarize the clinical experience in Da Vinci surgical system-assisted hepatopancreatobiliary surgery.Methods From January to December in 2009,94 patients with hepatopancreatobiliary diseases were treated at General Hospital of Second Artillery of PLA.The surgical procedure and postoperative recovery of patients were analysed.Results A total of 90 patients had successfully undergone robotic surgery,and 4 patients were converted to open surgery with the conversion rate of 4%(4/94).Sixteen patients received surgeries for hepatic diseases,and 1 patient with a giant hemangioma in the right posterior hepatic lobe was converted to open surgery,because a very close relationship between the hemangioma and inferior vena cava was observed;27 patients received surgeries for hilar diseases;19 patients underwent surgeries for pancreatic diseases,and 3 patients were converted to open surgery,including 2 with poor exposure of the giant pancreatic head carcinoma and 1 with tumors in the distal common bile duct:32 patients received other surgeries,including 6 with choledochojejunostomy and 11 with laparoscopic common bile duct exploration.Conclusions Almost all kinds of operations for hepatopanereatobiliary diseases could be performed by Da Vinci surgical system.Da Vinci surgical system expands the indications for laparoscopic surgery.

ObjectiveTo explore the value of expanded radical resection for gallbladder cancer located respectively at body and bottom of the gallbladder and at the neck.MethodsIn this study,91 cases of gallbladder cancer were macropathologically divided into two groups, one with the lesion at the body and bottom of the gallbladder and the other at the neck, survival analysis was made accordingly. Three different kinds of resection were performed: the expanded radical resection, the standard radical resection and palliative operation.ResultsThe overall median survival rate of patients undergoing expanded radical operation was significantly longer than that of the cases doing other two procedures, that was 27. 1 ± 2. 4,10. 7 ±2. 2,4. 7 ±2.2 (months) respectively for body and bottom cancer, and 8.5 ±2. 1,6. 7 ± 1.9,3.1 ± 1.1 (months) respectively for neck cancer. For cancer at the body and bottom RO was achieved by expanded radical resection in 16/18(88％ ) cases and by standard radical resection in 7/12(58％ ) cases, while for cancer at the neck it was in 6/16(38％ ) cases, and in 3/13 (23％)cases only.ConclusionsThe median survival time is longer and RO resection rate is higher in patients with the cancer at the body and bottom than these at the neck of the gallbladder.

Objective To explore the clinical safety and validity of Da Vinci surgical system in distal pancreatic tumor resection.Methods The clinical data of 14 patients with distal pancreatic tumor underwent robotic surgeries by using Da Vinci surgical system from January 2009 to June 2012 were retrospectively analyzed.Results The average operation time was 343.93 (170-575) min,average blood loss was 192.5 (10-700) ml,without blood trahsfusion.Pathologic examination showed:pancreatic ductal adenocarcinoma in 7 patients,pancreatic cystadenoma in 1 patient,mucous cystadenoma in 1 patient,cystadenocarcinoma in 1 patient,high levels of pancreatic ductal intraepithelial neoplasia in 1 patient,insulinoma in 1 patient,solid pseudo-papillary tumor in 2 patients.Two patients with pancreatic leaks after operation and then relieved after conservative medical therapy.Others were discharged from hospital without complications.The average hospital stay was 10.64 d.Conclusions Da Vinci surgical system is safe and effective in treatment for patients with distal pancreatic rumor with minimally invasive advantage.Because lack of surgical experience and small sample,a large sample with long term follow-up of high-quality clinical research is required and then update the system to evaluate the efficacy and safety.

Objective To analyze the correlation between serum anti-C1q antibody (anti-C1q Ab)and renal pathological characteristic,disease activity as well as some laboratory tests in patients with lupus nephritis (LN).Methods Serum anti-C1q antibodies were detected by enzyme-linked immunosorbant assay ELISA) in 120 patients with systemic lupus nephritis (SLE),which included 60 LN patients and 60 non-LN patients.Renal biopsy was conduted in all LN patients.The relationships between serum anti-C1q Ab level and renal pathohistology,lupus nephritis activity,as well as some laboratory parameters were analyzed.Results The mean level of serum anti-C1q Ab in LN patients was (89+26) U/ml,significantly higher than that of nonLN patients (57±23) U/ml (P＜0.01).Twelve cases of renal biopsies were classified as WHO Class Ⅱ,fourteen cases Class Ⅲ,eighteen cases Class Ⅳ,and sixteen cases Class Ⅴ.Significant difference of serum anti-C1q Ab level between each class was found by ANOVA test,and serum anti-C1q Ab level of Class Ⅳ was the highest (P＜0.01).Renal biopsies showed a positive correlation between serum anti-C1q Ab level and activity index of renal pathohistology (P＜0.01).Renal deposition of C1q was related with the level of serum anti-C1q Ab.Serum anti-C1q Ab level was positively correlated with proteinuria (P＜0.01),and negatively correlated with levels of C3 and C4 (P＜0.01).Mean level of serum anti-C1q antibody in SLE patients with positive antidsDNA was higher than that in the patients with negative anti-dsDNA (P＜0.01).Conclusion Serum antiC1q Ab level is significantly associated with lupus nephritis activity and renal pathohistology.It is a useful marker to predict renal lesion and disease activity in lupus nephritis.

BACKGROUND: Irradiation therapy in the cancer patients after surgery may have negative effects on implant fixation. OBJECTIVE: To observe the effects of 60Co irradiation and trace element zinc on fixation strengths of titanium implant. METHODS: Thirty-six adult male rabbits were involved. One piece of titanium implant was separately placed into the bilateral proximal tibial heads in rabbits to set up animal models of titanium implants. The animals were randomly divided into control group, zinc supplement group, 60Co irradiation group and 60Co irradiation and zinc supplement group. Zinc sulfate of 10 g/L was administered intramuscularly to animals in the zinc supplement group at the dose of 4 mg/kg once per day, and those in the control group were treated with saline at the same dose. The animals in the 60Co irradiation group received 60Co irradiation at the dose of 45 Gy and saline by intramuscular injection. Those in the 60Co irradiation and zinc supplement group received 60Co irradiation and zinc sulfate. The animals were killed at 1, 4 and 12 weeks after treatment. The fixation strengths were measured and compared among groups. RESULTS AND CONCLUSION: (1) Zinc supplement made the titanium implants have higher fixation strengths, and reach a high level at 4 weeks after surgery. (2) 60Co irradiation significantly inhibited the fixation strengths of the implants. After 60Co radiation, zinc supplement stil could promote fixation strengths of titanium implants. (3) It is indicated that amount of zinc supplement after irradiation therapy can al eviate the negative effects of irradiation on implant fixation.

Objective To investigate the role of miR-155 in diabetic nephropathy(DN)and its mecha-nism. Methods MiR-155 expression level in kidney was detected by real-time PCR and in situ hybridization. The target gene of miR-155 was predicted by bioinformatics and verified by Western Blot and double luciferase reporter activity. Western Blot was used to detect the related marker proteins of mesangial cells proliferation and mesangial matrix. Results (1)The expression of miR-155 increased in DN renal tissue and high glucose-stimulated renal cells.(2)MiR-155 was related to the regulation of Smad5 gene expression.(3)MiR-155 promoted the mesangial cells proliferation and increased extracellular matrix by down-regulating Smad5 expression. Conclusions MiR-155 can promote the mesangial cells proliferation and renal fibrosis by regulating Smad5 gene,providing a basis for further understanding the pathogenesis of DN.

Objective To assess the efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty (PTA) for treatment of stenosis of autogenous arteriovenous fistulas in maintenance hemdialysis patients. Methods From September 2016 to August 2017, thirty patients with autologous arteriovenous fistula (AVF) stenosis diagnosed in Guangzhou First People′s Hospital underwent PTA under the guidance of ultrasound for the first time. The vascular diameter of AVF stenosis and the blood flow of AVF before and after operation were evaluated. During the follow-up period,the patency time and complications were recorded. Results In 93. 3%( 28/30) patients, primary ultrasound-guided PTA procedures were successfully performed. The internal diameter of the stenosis increased from (1. 62±0. 30) mm preoperatively to (3. 61±0. 66) mm postoperatively (t＝18. 205,P＜0. 001),and the natural blood flow increased from (270. 0±36. 5) ml/min preoperatively to (611. 4±46. 6) ml/min postoperatively (t＝50. 221,P＜0. 001). The post-intervention primary patency rates at 90 and 180 d were 96. 4%(27/28) and 85. 7%(24/28), respectively. There was no rupture of the vein,or other severe complication during the PTA procedure. One patient had perilesional swelling,and one patient had extravasation after the PTA procedure. Conclusion Ultrasound-guided PTA is a safe and effective method for treatment of stenosis of autogenous arteriovenous fistulas in maintenance hemdialysis patients.